This proposal describes the five-year K23 Mentored Patient-Oriented Research Career Development Award of Jamie Feusner, M.D. The overall goals are to provide him with the conceptual background and research skills necessary to conduct patient-oriented research on body dysmorphic disorder (BDD). The candidate will train in functional neuroanatomy, functional neuroimaging, neuropsychological testing, biostatistics, research design, standardized assessment, and research ethics. He will received guidance from his mentors Drs. Susan Bookheimer and Alexander Bystritsky as well as outside consultants in an organized program of supervised research and coursework at UCLA and the BDD Research Unit at Massachusetts General Hospital, and the BDD research lab at Brown University. BDD occurs in approximately 1-2% of the population. It is a severe and disabling psychiatric condition with a lifetime suicide attempt rate of 25%, yet is vastly underrecognized and understudied. Individuals with BDD are obsessed with perceived defects in their appearance and experience extreme shame, anxiety and dysphoria related to them. When viewing themselves and others, they tend to focus on specific details of skin, hair, noses, etc. This, and neuropsychological data, suggest that impaired visual information processing may underscore the pathophysiology. The goal of the proposed project is to study visual processing in individuals with BDD using functional magnetic resonance imaging (fMRI). In the first phase of the study regional brain activation patterns will be compared in individuals with BDD vs. controls, with respect to the processing of high and low-spatial frequency (level of detail) when viewing others'faces. The results will indicate if BDD subjects process faces preferentially using regions/networks of the brain responsible for high- detail processing. In the second phase, fMRI will similarly be used to identify regional brain activation patterns for a task involving processing of photographs of the subjects'own faces (that they perceive are defective) in order to determine further visual processing abnormalities activated with emotional arousal. Relevance: Determining patterns of visual processing in body dysmorphic disorder potentially could be used to develop focused, long-term effective treatments that address correcting the core abnormal processes that contribute to the symptoms. This project will also allow Dr. Feusner to meet his training objectives.